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ADHD and Drugs that Suppress Play

 

Your mother may have told you: “Just because you can do something, doesn’t mean you should do it.”  The medical correlate to this is: “Even if you are eligible for a particular treatment, you should still think about whether it is the best option for you.

I am commonly asked about my thoughts on the use of amphetamines and amphetamine-like drugs to treat hyperactive children. The idea has been that amphetamine-like drugs stimulate the self-control pathways in the brain and help those taking them focus.  While more common in children, recently I was asked by an adult patient interested in starting amphetamines to help focus at work and improve productivity. Not surprising, since the treatment of ADHD has extended to adults as millennial grade schoolers have progressed to college and careers.

I have never been supportive of placing children – usually young boys and often at the bequest of schoolteachers – on amphetamines without careful examination of the individual benefits and risks. BTW, the individual patient benefit versus risk approach is useful for all therapies.

I was a young boy many years ago, and more recently as a father and grandfather have experience with other young and very young men.  Boys need activity and play. Back in the day, school was different. I must have learned something in school, but I remember almost nothing of the classroom activities. Those were incidental.  I do remember that we had a liberal amount of playtime, and sometimes I was just hanging on in class until I could get outside and burn off some energy by running around. In my high school, we had a daily hour period of physical education.

When my children were in school (1990-2010) playtime took up less of the school day, although my boys both seemed to live for recess as well. Playground injuries made recess seem like the high risk part of the curriculum.

I recently heard of a new insight into play, attention deficit hyperactivity disorder and the pharmacological effects of amphetamines.  Researcher Jaak Panksepp (link below) has studied rat behavior for many years and identified a number of emotions common to rats and humans with some interesting implications.

Rats have long provided insight into learning and social development.  Young rats play with one another according to a set of social rules that allows them to mature into useful members of the rat community.  Young rats play games that have been recognized by psychologists, and play these games regularly and measurably. Play makes a necessary contribution to socialization – knowing how to get along with others.

Amphetamines and Amphetamine-like Drugs


Panksepp found that amphetamines – drugs used for attention deficit in children – suppress play in rats.

If we extrapolate this to humans, we have a subset of children who fidget in school (or worse!) – who may want or need to play.  If given amphetamine-like drugs, they perform better in school; apparently they might not need to play as much.

It’s intriguing that there are drugs that might suppress our need or desire for play. Perhaps there are other drugs that enhance the desire to play and which might get us outside running, jumping and climbing monkey bars.

“Should I give my child medications to help him do better in school?”  Good question.  There will be some children for whom there is no other option.  But Panksepp’s work suggests that there may also be another “therapy” – play – that might also help some children.

Most drugs carry benefits for patients as well as risks or adverse effects. Talk to your prescriber and pharmacist to understand what those benefits and risks are so that you can make an informed decision. Take good care of yourself.

 

Resources

PubMed Health: Attention Deficit Hyperactivity Disorder (ADHD)

https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024867/

Discover Interview: Jaak Panksepp Pinned Down Humanity’s 7 Primal Emotions

page 4 of 5 includes work related to play and amphetamines

http://discovermagazine.com/2012/may/11-jaak-panksepp-rat-tickler-found-humans-7-primal-emotions

About Dr. Peter J. Rice

Dr. Peter J. Rice is a professor of Pharmacology emeritus at the East Tennessee State University Quillen College of Medicine and Professor of Clinical Pharmacy at the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences. --------------------------------------------------------------------------He received his BS in pharmacy from Northeastern University, PhD in pharmacology from the Ohio State University and PharmD from the University of Kentucky. He is a Board Certified Pharmacotherapy Specialist and practices in the ambulatory care and community pharmacy settings. Professor Rice is the author of Understanding Drug Action: An introduction to pharmacology (APhA, 2014) and is a fellow of the American Pharmacists Association. --------------------------He welcomes interesting medication questions and suggestions for future columns.